What is Bursitis?
Bursitis is the inflammation of one or more bursae (small sacs) of synovial fluid in the body. The bursae rest at the points where internal functionaries, such as muscles and tendons, slide across bone. Healthy bursae create a smooth, almost frictionless functional gliding surface making normal movement painless. When bursitis occurs, however, movement relying upon the inflamed bursa becomes difficult and painful. Moreover, movement of tendons and muscles over the inflamed bursa aggravates its inflammation, perpetuating the problem.
Shoulder bursitis (also called subacromial bursitis) occurs when the bursa (a fluid-filled sac on the side of the shoulder) becomes damaged, irritated, or inflamed. Bursitis (“-itis”); means “inflammation”) means the bursa has become irritated and inflamed, which causes pain. Normally, the bursa acts as a cushion for the rotator cuff tendon of the supraspinatus muscle that sits under the bursa, and prevents the tendon from rubbing on the acromion bone above the bursa. Certain positions, motions, or disease processes can cause friction or stress on the bursa, leading to the development of bursitis. When the bursa becomes injured, the tendon doesn’t glide smoothly over it, and can become painful.
Shoulder bursitis can be caused by:
- Repetitive motions (overhead reaching or lifting, throwing, or twisting of the arm)
- Muscle weakness or poor muscle coordination
- Incorrect posture
- Direct trauma (being hit, or falling on, the side of the shoulder)
- Shoulder surgery or replacement
- Calcium deposits in the shoulder
- Overgrowth or bone spurs in the acromion bone
- Autoimmune diseases, such as rheumatoid arthritis, gout, psoriasis, or thyroid disease
- Muscles or tendons in the shoulder area rubbing the bursa and causing irritation
How Can Physical Therapy Help?
Based on the evaluation, our physical therapists will develop a customized rehabilitation program for you. In the acute stage this might include modalities to reduce inflamation and irritation of the Bursea and surrounding soft tissue such as ultrasound and electrical stimulation as well as cryotherapy and thermotherapy. As the Bursea settles then manual therapy and exercises are incorperated to adress and strength and /or mobility deficites. Finally, the goal is to return to normal functioning, so ergonomics and functional movement analysis and corrective measures are adressed to aid in the final stages of recovery.
Your physical therapist will work with you to design a specific treatment program that will speed your recovery, including exercises and treatments that you can do at home. Physical therapy will help you return to your normal lifestyle and activities. The time it takes to heal the condition varies, but results can often be achieved in 2 to 8 weeks, when a proper stretching and strengthening program is implemented.
During the first 24 to 48 hours following your diagnosis, your physical therapist may advise you to:
- Rest the area by avoiding lifting or reaching overhead, or any activity that causes pain.
- Apply ice packs to the area for 15 to 20 minutes every 2 hours.
- Consult with a physician for further services, such as medication or diagnostic tests.
Your physical therapist will work with you to:
Reduce Pain and Swelling. If repetitive activities have caused the shoulder bursitis, your physical therapist will help you understand how to avoid or modify the activities to allow healing to begin. Your physical therapist may use different types of treatments and technologies to control and reduce your pain and swelling, including ice, heat, ultrasound, electrical stimulation, taping, specific exercises, and hands-on therapy, such as specialized massage.
Improve Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the shoulder and arm. These might begin with “passive” motions that the physical therapist performs for you to gently move your shoulder joint, and progress to active exercises and stretches that you do yourself.
Improve Flexibility. Your physical therapist will determine if any shoulder, arm, chest, or neck muscles are tight, start helping you to stretch them, and teaching you how to stretch them.
Improve posture. If posture problems are found to be related to your condition, your physical therapist will work with you to help improve your posture to help alleviate your pain, and prevent future recurrence.
Improve Strength. Shoulder bursitis is often related to weak, injured, or uncoordinated shoulder muscles. Certain exercises will aid healing at each stage of recovery; your physical therapist will choose and teach you the correct exercises and equipment to use to steadily restore your strength and agility. These may include using cuff weights, stretch bands, and weight lifting equipment.
Improve Endurance. Regaining your muscular endurance in the shoulder is important after an injury. Your physical therapist will teach you exercises to improve your muscular endurance, so you can return to your normal activities. Cardio-exercise equipment may be used, such as upper-body ergometers, treadmills, or stationary bicycles.
Learn a Home Program. Your physical therapist will teach you strengthening and stretching exercises to perform at home. These exercises will be specific for your needs; if you do them as prescribed by your physical therapist, you can speed your recovery.
Return to Activities. Your physical therapist will discuss your activity goals with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. Your physical therapist will teach you exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your goals.
Speed Recovery Time. Your physical therapist is trained and experienced in choosing the best treatments and exercises to help you safely heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.
If Surgery Is Necessary. Surgery is not commonly required for shoulder bursitis. But if surgery is needed, you will follow a recovery program over several weeks, guided by your physical therapist. Your physical therapist will help you minimize pain, regain motion and strength, and return to normal activities in the safest and speediest manner possible.
How Does it Feel?
With shoulder bursitis, you may experience:
- Pain on the outer side or tip of the shoulder
- Pain when you push with your finger on the tip of the shoulder
- Pain when lying on the affected shoulder
- Pain that worsens when lifting the arm to the side
- Pain when rotating the arm
- Pain when pushing or pulling open a door
Bursitis is commonly caused by repetitive movement and excessive pressure. Elbows and knees are the most commonly affected. Inflammation of the bursae might also be caused by other inflammatory conditions such as rheumatoid arthritis. Although infrequent, scoliosis might cause bursitis of the shoulders; however, shoulder bursitis is more commonly caused by overuse of the shoulder joint and related muscles. Traumatic injury is another cause of bursitis. The inflammation irritates because the bursa no longer fits in the original small area between the bone and the functionary muscle or tendon. When the bone increases pressure upon the bursa, bursitis results. Sometimes the reason is unknown. It can also be associated with some chronic systemic diseases.